Well-being effects of extreme weather events in the United States

The increase in weather and climate disasters in recent years has prompted an interest in analyzing their consequences and the mitigation and adaptation measures that can help minimize their potentially large impacts on individuals’ welfare. We match thirty-one billion-dollar disasters with individual survey data from the Behavioral Risk Factor Surveillance System to estimate the effect of extreme weather events on the subjective well-being of U.S. residents. Our results indicate that natural disasters have a negative and robust impact on subjective well-being in the affected communities, and that, on average, this impact peaks 6 months after the event, and then decays over time. We then investigate the attenuating impact of health care access, flood insurance, and governmental assistance programs and find a partial compensating role for risk-transfer and relief measures. We also find that stronger emotional and social support mitigates the negative impact of natural disasters.     

Healthcare resource utilization by patients with treatment-refractory myasthenia gravis in England

Aims: To examine healthcare resource utilization associated with refractory myasthenia gravis (MG) in England.

Materials and methods: This was a retrospective cohort study of linked data from the Clinical Practice Research Datalink and the Hospital Episode Statistics database collected between 1997 and 2016. Included patients were ≥18?years of age at the index MG diagnosis. Patients with refractory MG were identified using an algorithm based on treatments received. Healthcare resource utilization since the index date was compared between refractory and non-refractory cohorts.

Results: The study included 1149 patients with MG, of whom 66 (5.7%) were refractory. Sex and age at diagnosis did not significantly differ between the refractory and non-refractory cohorts. Rates of healthcare resource utilization per person-year were significantly higher (p?p?Limitations: The algorithm for identifying refractory patients did not include clinical criteria. Also, treatments administered in hospitals or by specialists were not available in the databases.

Conclusions: Patients in England with refractory MG more often visit healthcare providers, are hospitalized and visit an emergency room than patients with non-refractory MG.     

名山风景区风景特质理论体系及其实践 ——以武当山为例

名山风景区“人与天调”的风景系统代表了中国独有的山岳文化现象和山水相融的总体特征。在风景自然和文化整体性视角下研究风景系统的形态、类型及其形成原因和规律，分析了风景资源评价和风景特质评价的互补性；构建了“相-制-理”的名山风景区风景特质理论及其实践框架。以武当山为例，探索“以脉绘景”的风景特质之相、“山川流峙”的风景特质之制以及“因脉而成”的风景特质之理。最后总结了风景特质理论作为形态学理论、作为图谱理论、作为地脉文脉认识论实践的整体性特点及其应用前景。     

An evolutionary complex systems perspective on urban health

Deliberations about how to govern complex problems of urban health and wellbeing sustainably have often been implicitly biased by ideas such as being ‘human-scale’ or ‘people-centered.’ With increasing urban populations and increasing urban system interconnectivity, many cities have transformed into city regions or clusters, and the external effects of urban growth are carried mainly by the marginalized and the environment putting urban health increasingly at risk. Here we address the question of why human societies have not been better at collectively adapting to the challenges of urbanization and global environmental change? We build a theoretical framework of multi-level selection, complex systems evolution, and governance, following which we then present ‘human-scale’ and ‘people-centered’ ideas of urban development as expressions of two types of socio-political organization with different degrees of self-organization. We found several reasons for which the maladies of current urban development emerged and the seeming inability to resolve them. First, urban systems became increasingly interconnected and evolved into ultrasocial superorganisms, displaying preference to sustain themselves as a whole rather than their subordinates. Second, the difference in scaling effects between the biological and the social network contributed to the mismatch between rapid urban growth and slow adaptation. Furthermore, institutions of decreased variety reinforce themselves and become dominant, creating a positive feedback mechanism and promoting invasive and exploitative exponential growth, but they also reduce the creativity and resilience of urban systems. We also found that both the “human-scale” and the “people-centered” approaches acknowledge the exponential growth and decreasing variety in urban systems, and advocate for correcting the mismatches. To incorporate people's needs and values for long-term, truly sustainable urban health governance, we recommend combining the self-organizing, evolutionary feature of “human-scale” and the coordinative, political feature of “people-centeredness.”     

粮食主产区耕地健康产能评价 ——以河南省温县为例

研究目的:探寻适合中国新时代耕地产能评价的新理论与方法,界定耕地健康产能内涵,构建评价指标体系,并应用河南省温县验证。研究方法:基于"需求—功能—维度—要素—指标"理论框架,构建耕地健康产能评价指标体系,运用综合算法、"1+X"累加模型法、图层叠加法定量评价耕地健康产能。研究结果:(1)温县耕地产能和耕地健康诊断结果地域分异特征明显,以青峰岭为界,北部耕地产能和健康状况较南部好;(2)耕地健康产能整体状况良好,乡镇间差异明显;(3)耕地健康产能结果更多取决于耕地健康诊断,主要受耕地生产环境和耕地系统弹性影响。研究结论:耕地健康产能评价指标体系和评价方法有应用性。     

Taxation and the Environment–Health–Poverty Trap: A Policy Experiment Perspective

Under pressures related to economic growth and environmental protection, China is facing an increasingly severe “environment–health–poverty” trap risk. Fuel taxation is generally considered an effective policy to counter such a risk. Since 2009 China has raised the fuel tax rate many times to enhance tax reform. However, the effects of this policy remain unknown. Therefore, it is vitally important to estimate the impacts of China's current fuel taxation policy on environment, public health and the national economy. As the first attempt in existing literature on China, this paper builds a general equilibrium framework with the feedback effect of public health on economy. We find that that the fuel tax policy benefits the adjustment of the economic structure and improves human health; however, it is detrimental to economic growth, public welfare and price stability. In this sense, it plays a limited role in reducing the trap risk and might not be sustainable in the long term.     

In Data We Trust? An Analysis of Indonesian Socioeconomic Survey Data

What if a popular dataset that has generated a large amount of literature has been misunderstood and has led to misleading inferences? This paper examines household expenditure data from the Indonesian National Socio-economic Survey (Susenas), which started more than 50 years ago. Appropriate use of Susenas data for policy analysis requires an understanding that the survey’s expenditure variable does not measure true out-of-pocket expenses, because it includes subsidies received by households when obtaining goods and services. We also highlight an abrupt change in the survey instrument that occurred in 2015, when the reference period for certain items was extended. For health items, this generated a change in the expenditure series that can be misinterpreted as being the result of a social health insurance reform introduced in 2014 to lower the health care burden on households. Accordingly, we propose a way to account for this artificial expenditure movement in Susenas.     

Do health system reforms stand a chance?

While most major reforms of health systems fail, those that succeed are motivated by politicians' quest for reducing the health burden on their budget in response to a shift in voters' preferences away from public health. An Edgeworth box is used to depict their preferences, in addition to those of (potential) patients and health‐care providers. Politicians are found to severely constrain the area of mutual advantage, suggesting that only minor reforms are possible unless they promise to lower health‐care expenditure. An efficiency‐enhancing change that would enlarge the box and hence the area of mutual advantage would be to suppress the requirement imposed on health insurers to purchase domestically, rather than being free to directly import health‐care services and drugs.     

Is health care a necessity or a luxury? Evidence from urban China

This article uses a smooth transition regression (STR) model to research the income elasticity of the health care expenditure of China’s urban residents in the 1990–2013 period. The results demonstrate that if the real income of China’s urban residents that lags a period is taken as a transition variable, urban residents’ health expenditure follows an LSTR1 nonlinear two-regime model. Here, the income elasticity of health care expenditure of China’s urban residents is 1.4919 in 1990–2002 and 1.2216 in 2003–2013. Overall, the income elasticity of health care of China’s urban residents is greater than 1, indicating that health care is a luxury.     

Prioritization of government expenditure on health in India: A fiscal space perspective

Unequal distribution of fiscal resources and lower prioritization of budget towards healthcare are the most important challenges in achieving universal health coverage in India. This study has examined relationships between government health expenditure and fiscal space (i.e. tax revenue, non-tax revenue, fiscal transfer, and borrowings) in twenty-one states of India for the period of 1980–2014. Our panel regression results imply that mobilization of tax revenue has a positive impact, while borrowings have a negative impact on the allocation of government expenditure on healthcare in the long-run. The panel quantile regression results show that states associated with the low and middle level of revenue growth have been mobilizing finance through central government transfer and borrowings in short-run. Further, the panel vector error correction models show that sum of the lagged coefficients of borrowings have a greater impact on health financing process as compared to other sources of fiscal space at short-run, and the speed of adjustment towards long-run equilibrium is relatively slower. The overall analysis concludes that less domestic revenue mobilization and higher dependency of borrowings for healthcare financing may create fiscal stress on state finances in the long-run, and thereby it could possibly reduce the prioritization of spending. Therefore, improvement in revenue growth and proper utilization of fiscal transfer would be appropriate policy implications from this study.